Coach House Sports Physiotherapy Clinic (FORMERLY CARNEGIE)

Osteitis Pubis and Groin Pain

Osteitis pubis can be used to describe pain emanating from the pubic symphysis, which is the joint where the two halves of the pelvis come together at the front of the pelvis. The pelvic bones form a ring with the pubic symphysis at the front and are joined at the back of the pelvis at joints on each side of the sacrum ( the sacro-iliac joints). The pubic symphysis is a thin joint which under normal circumstances has very minimal motion. In osteitis pubis, or with other types of groin pain, the pubic symphysis can be out of line, with one side higher or lower, or further forward or back than the other. It can also move more than it should during movement walking, and it is this malalignment and excess movement that can result in inflammation and pain

Osteitis pubis is thought to result from inflammation of the pubis symphysis and is characterized by pain, and sclerosis and bony changes of the pubis symphysis, which can be seen on xray and MRI scan. It can be very debilitating for sportsmen and women and for women post childbirth. In addition to being very painful, it can cause muscle inhibition, and feelings of weakness and loss of power. It can also result in a loss of technique and performance.

Causes of Osteitis Pubis

Osteitis Pubis can have a number of different causes and it is this that can make it a difficult problem to get rid of. We have found that the more complex and resistant cases of osteitis pubis have many of the causative factors, and that unless the physiotherapist is able to address most or all of them, the result is likely to be less good, especially in the sporting population.
The pubic symphysis can be an area that becomes notoriously difficult to heal once it has become chronic. Causes of osteitis pubis can include the following, which are also factors that can prevent or slow down the healing process, causing ongoing pain.

• Sports activities ( football and rugby are most common)
• Surgical procedures (gynaecologic or abdominal, hernia repairs)
• Pregnancy and childbirth
• Trauma/injury
• Spinal malalignment
• Pelvic malalignment ( the pubic symphysis itself may be out of line)
• Poor posture
• Leg length difference
• Foot biomechanics
• Technique- walking and /or running
• Poor flexibility
• Poor muscle strength and recruitment, although muscles can also become overactive
• Breathing issues
• Reduced core strength and control of the spine and pelvis during activity
• Visceral ( organs in the abdominal or pelvic cavity) organs may become affected, which can refer pain, or cause pelvis malalignment
• Hip problems

• Poor balance

Symptoms of Osteitis Pubis

The most common symptom of osteitis pubis is pain over the front of the pelvis. The pain is often central, although can be worse on one side than the other. It can also radiate down into one thigh or into the groin. It is possible to have similar pain in the groin without having full osteitis pubis and it would still be treated in a similar way
Other symptoms can include

• Weakness
• Limping gait
• Pain during sport
• Change of technique through inhibition of muscles
• A feeling of generally being “crooked”
• Pain in the groin

• Pain in the lower abdomen

X-rays of patients with osteitis pubis typically show an irregular pubic symphysis with sclerotic (thick) bone edges and evidence of chronic inflammation. An MRI test is usually not needed, but will show inflammation of the joint and the surrounding bone.

Getting Rid of Osteitis Pubis

Generally when a client presents with osteitis pubis or chronic groin strain, there is usually a mitigating factor that is preventing it from healing. This may be that the joint itself is out of line for some reason, or that the muscles that function around the pelvis are too tight, too weak or overactive. This can cause changes in the way you move or stand. Invariably it is this that is not allowing the area to heal and the resultant pain in the pubic symphysis then causes further dysfunction in the body, as it tries to compensate. It is only by re-aligning the spine and pelvis and stretching and/or strengthening the muscles around the trunk, pelvis and lower limb, and re-training how we use those muscles, and the way we walk or run, that we can start to allow the painful area to heal. This is sometimes why cortisone injections may not work in the area (although they can be effective)

It is always important to find out why the osteitis pubis came on initially. We have seen some cases where the groin pain has arisen because of issues with the shoulder or neck for example.

Treatment of Osteitis Pubis

The physiotherapist will take a thorough case history and will assess all of the causative factors described above.
Treatment will then begin to address these issues, aiming to help re-align the spine and pelvis, to reduce pain and normalise the way you move
Treatment can include

• Spinal and pelvic alignment work
• Muscle energy techniques
• Soft tissue work and stretching
• Myofascial release
• Lower limb and core muscle strengthening
• Referral to podiatry if necessary for leg length assessment and biomechanical analysis
• Visceral work if required- this can often hold the body out of alignment
• Postural analysis
• Retraining of walking and running technique
• Retraining of technical skills
• Balance retraining
• Home exercise program

• Breathing retraining

Treatment of osteitis pubis is most successful, particularly in the more chronic cases if all of the above are addressed if required. We have had a large amount of success in treating osteitis pubis at CSPC by treating it in this way, and with the greatest chance of non-recurrence. With the high level sportsperson, we may also have to retrain running technique, and the way they move during their sport, for example around a football pitch. We frequently see patients with osteitis pubis who have also developed issues with breathing, which further exacerbates symptoms and movement dysfunctions, which must also be retrained.

Preventing Recurrence

If osteitits pubis and groin pain are treated by addressing all of the causes and not just the symptoms, there is a greater chance that the injury will not return, or if it does, it will not be as bad as it was initially. Most of the resistant cases are caused by technique, biomechanics, visceral issues, surgeries, accidents and breathing issues, and by being thorough and addressing as many of the issues as possible, the sportsperson should be able to return to high level sport, often performing at a higher level, as many of these issues have been present for years, causing other minor injuries, until they result in this major injury which needs to be fully addressed and rehabilitated.

Testimonial- David Falconer -Semi professional football player
I travelled to see Alison from Glasgow having suffered from osteitis pubis for around a year and after hearing good reports regarding her treatment of this condition.
After trying numerous physiotherapists, ART therapists, acupuncturists, chiropractors/ osteopaths, & surgeons in Scotland with no great results, I did have my doubts as to whether I would ever be able to play football pain free again and was contemplating hanging up my boots- luckily I heard about Alison, and I haven’t looked back.
The attention to detail and anatomy knowledge I experienced was unbelievable and the best I have ever received- every aspect of my body, posture, and breathing was analysed over a two day period that addressed every fundamental weakness/ issue I had.
Even though the aches, and pains that had plagued me for over a year felt better after these initial two days it was after a week+ of doing the exercises given to me that I seen a huge difference. I am now at the stage where I can play pain free and I can’t thank/ recommend Alison, and the clinic highly enough.

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